This chapter briefly reviews the principles of medical treatment for patients in the vegetative state but without discussing the details of techniques that depend on the expertise of therapists in rehabilitation teams. The significance of the setting in which these patients are treated is important to recognize. Because this condition is relatively rare, any one hospital or doctor is unlikely to encounter more than the occasional vegetative patient, with the exception of the very few rehabilitation units that have a special interest in this condition. In a review of over 1000 UK doctors in specialities likely to encounter vegetative patients 46% had never encountered one, 31% had seen less than five and only 10% more than ten (1).

In the early stages these patients are in acute units – neurosurgical, orthopaedic, neurological, medical or intensive care. In many places there is pressure to discharge these patients early from such acute settings, but there are very few rehabilitation units willing or able to take such dependent patients within a few weeks of the acute insult. There are some units of this kind in the USA but for patients that reach them there are often difficulties in maintaining funding for more than a month or so of treatment unless the patient is already showing enough improvement to claim that active rehabilitation should continue to be supported. As a result many of these patients are soon transferred to nursing homes with skilled nursing facilities but which do not have specialized rehabilitation programmes.